Surgeons keep jobs after botched operation on pregnant woman who later died

Tribunal allows doctors to continue practising as a surgeons despite errors
where woman's ovary was removed instead of her appendix

Mr Al-Abed, left, made the fatal error after attempting a complicated operation on Maria De JesusPhoto: CENTRAL NEWS/NIGEL HOWARD

By Keith Perry and agency

12:15PM BST 15 May 2014

A consultant surgeon and a junior doctor have been allowed to keep their jobs after a pregnant woman died when her ovary was removed instead of her appendix.

Junior surgeon Yahya Al-Abed was left unsupervised because a consultant surgeon who was meant to perform the surgery went home for a nap. The less experienced doctor who was "out of his depth", accidentally removed her ovary after mistaking it for her appendix.

Mr Al-Abed made the fatal error after attempting the complicated operation on Maria De Jesus, 32, at Queen's Hospital, Romford, Essex.

Senior consultant surgeon Babatunde Julian Coker should have performed the procedure himself or at least supervised the registrar, but instead went home for an afternoon sleep, leaving junior surgeon Mr Al-Abed and a fourth year trainee to carry out the complex operation between them. During the operation Mrs De Jesus lost 1200ml of blood as well as having the wrong organ removed.

Both Mr Al-Abed and Mr Coker were found guilty of "serious misconduct" at the Medical Practitioners Tribunal Service in Manchester after their behaviour was said to have put their patient at "unwarranted risk of harm" and "brought the profession into disrepute". However, both surgeons will be allowed to carry on practising.

The mother of three, who was 20 weeks pregnant with her fourth child, died 19 days later after suffering a miscarriage and undergoing a second procedure to remove her appendix.

Mr Al-Abed admitted he made a number of errors during the procedure, including removing her right ovary instead of her appendix.

Her husband Adelino and their three children attended the hearing only to find out that neither doctor would serve a practise ban.

The tribunal heard that Mrs De Jesus, referred to as Patient A, was admitted to hospital with severe abdominal pain on 21 October 2011.

Mr Coker had told fourth-year trainee Christopher Liao he was "happy to help" to remove her appendix after she was diagnosed with appendicitis two days later.

In fact it was the on-call registrar, Mr Al-Abed, who carried out the procedure and Mr Liao stepped in to help when things started to go wrong on 23 October 2011.

Mr Al-Abed even allowed off-duty second-year trainee Osman Chaudhary to make the first incision after he asked to help, despite his inexperience.

All three junior doctors had been at the hospital for just 19 days.

Mr Al-Abed has said he felt competent to perform the procedure although now accepts he was "out of his depth" and needed the supervision of a consultant.

During the procedure Mrs De Jesus began to bleed heavily and 'in the midst' of the bleeding the medic removed what he thought to be her appendix.

Despite the complications, Mr Coker was not called before, during or after the surgery and only found out the operation had taken place on his ward round the next morning.

He claimed he had always intended to be involved in the operation, but the panel found he had effectively 'delegated' responsibility.

Mrs De Silva was discharged from hospital ten days later on 31 October 2011.

But she returned to the Romford hospital on November 7, still in serious pain, when another doctor discovered that it was in fact her right ovary that had been removed instead of her appendix.

She gave birth to a still-born boy and died on the operating table on November 11 following a second operation to remove the organ, the tribunal heard.

The post-mortem concluded she had died of multiple organ failure brought on by septicaemia.

MPTS panel chair, Carrie Ryan-Palmer, said: “The panel wishes to offer it's sincere condolences to the family and to reiterate that we acted within our jurisdiction and remit.”

It has previously stated it restricted its deliberations to the doctors' actions and omissions on 23 October 2011 and not the subsequent 'tragic events'.

Mr Al-Abed was made subject to an 18-month order of conditional registration and Mr Coker was placed under conditions for a year. They will be kept closely monitored by the General Medical Council and will have to attend a review hearing before they return to unrestricted work.

Mrs Ryan-Palmer told Al-Abed, who now works at Colchester Hospital, Essex, his errors during the operation were 'avoidable' had he followed procedures or stopped and waited for consultant support.

The GMC had called for him to be suspended, but the panel decided that it was not in the 'wider public interest' to remove him from practice and instead decided he should be made subject to 'strict monitoring and supervision'.

Mrs Ryan-Palmer told him: “The panel bore in mind that it is not necessary to remove from practice an otherwise competent and useful doctor who presents no danger to the public in order to satisfy public demand for blame and punishment.

“In this regulatory context, misconduct arising from honest failure, as opposed to cavalier disregard for principles of good medical practice, should not attract blame and retribution but must prompt learning and a drive to reduce the risks for future patients.

“The panel was satisfied that this end could be achieved by a period of conditional registration.”

Mr Coker was found to have failed in his duty of care to his patient when he effectively 'delegated' responsibility to a trainee whose capabilities he was not familiar with.

The GMC wanted him suspended, but the panel found his 'poor judgement' was an 'aberration' from his normal high standard of practice over his 30-year career.

Mrs Ryan-Palmer told him: “No reasonable observer could conclude that your actions and omissions were anything other than unacceptable.

“The panel's findings of misconduct and impairment have sent a clear and robust message to you, to the medical profession and to the public about the seriousness with which your actions are viewed.

“The panel was of the view that conditions would provide a framework of monitoring by your professional regulator which would provide assurances that your practice will be restricted until such time as you are able to demonstrate that you are fit to practise without limitation.”

Recording a narrative verdict, an inquest in Walthamstow, east London, coroner Chinyere Inyama said a lost window of opportunity could have saved Mrs De Jesus.

Barking, Havering and Redbridge Hospitals Trust admitted liability for her death apologised to her family.

It was not alleged any of the doctors' failings on 23 October led to her death and the panel has said it is outside of its remit to look beyond the events of the 23 October operation.

Mr Al-Abed, represented by David Morris, admitted failing to inform the consultant, involving a junior doctor in the operation without having the experience to supervise him and removing the patient's ovary in error.

He was cleared of failing to examine his patient pre-operatively, but the panel found he failed to record 'an update on post-operative orders'.

Mr Coker, represented by Neil Sheldon, admitted to failing to appropriately undertake his role in not attending or supervising the operation.

The panel found against him on three outstanding charges - that he did not delegate the surgery to a registrar whose capability he was familiar with, did not ascertain whether an operation had been carried out or find out the result of that operation.